Please list any medications, including nonprescription, which your child takes below. These medications will be given to the Student Ministry Director or a designated sponsor for safe keeping and will be administered according to directions. Students are not to hold any medications in their possession unless special arrangements are made in advance with the Student Ministry Director or a designated sponsor.

Please list any medications, including nonprescription, which your child takes below. These medications will be given to the Student Ministry Director or a designated sponsor for safe keeping and will be administered according to directions. Students are not to hold any medications in their possession unless special arrangements are made in advance with the Student Ministry Director or a designated sponsor.

I give permission to the Student Ministry Director and/or youth sponsors to authorize emergency medical treatment for/our son or daughter on any youth ministry sponsored event during the 2022-2023 school year. I understand that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. I also agree to not hold First United Presbyterian Church, Moline, IL liable for any incident that may result from participation in any of our activities or events, as a result, of my child's participation in its activities. Furthermore, I agree to reimburse First United Presbyterian Church, Moline, IL for any medical expenses.

In case of medical emergency, I understand that every effort will be made to contact the parents or guardians of the participant. In the event that I/we cannot be reached, I hereby give permission to the physician selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary. Below are any special instructions or information that would be pertinent in case of a medical emergency.